Tregolls Manor

The service is a detached property that has accommodation over three floors. A lift enables people to access all parts of the service. Some bedrooms have ensuite facilities and people share communal lounges and have access to a garden. Tregolls Manor is in the city of Truro in Cornwall.

People’s experience of using this service and what we found

People told us they were ‘happy’ living at Tregolls manor and their care needs were met by caring and skilled staff. Comments included “I feel safe and well cared for”, “Staff are lovely” and “Marvellous”.

Relatives were complimentary about the care their family members received. Comments included “The care here is excellent. Not just the material care, they are very caring, very passionate” and “[Person’s name] enjoys the company and the stimulation, [Person name] said they had been spoilt rotten” and “ I think they have got it really right here. It is a patient, caring environment”.

Since the last inspection there had been a successful recruitment campaign. A deputy manager, care staff, housekeeping and catering staff had all been employed. Staffing levels were appropriately managed, and people received care from consistent, regular staff

People, relatives and staff were all positive about the management team. Comments from people included, “We have good managers here”.

Safeguarding processes were in place to help safeguard people from abuse.

The deputy manager had reviewed every person’s care plan and risk assessment to ensure they were clear and up to date. This meant guidance was in place for staff to follow.

Medicines were administered and managed safely. Staff maintained accurate medicines administration records.

The service was clean and there were additional cleaning procedures in place to limit infection control risks within the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The management team maintained oversight of complaints, accidents and incidents and safeguarding concerns. The management team engaged well with health and social care professionals.

Peoples care records were stored securely.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 15 October 2021).

At our last inspection we found breaches of the regulations in relation to medicines, notifying us of incidents they were legally required to do, and governance systems. The registered manager completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was now meeting these regulations.

Why we inspected

We carried out an unannounced inspection of this service on 7 September 2021. Breaches of legal requirements were found in relation to medicines, notifying us of incidents they were legally required to inform us of and governance systems.

We undertook this focused inspection to check if the provider had made improvements and if they were now meeting the legal requirements. This report only covers our findings in relation to the key questions safe, responsive and well-led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Tregolls Manor on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Tregolls Manor is registered to provide accommodation with personal and nursing care for up to 25 people. There were 20 people using the service at the time of our inspection.

The service is a detached property that has accommodation over three floors. A lift enables people to access all parts of the service. Some bedrooms have ensuite facilities and people share communal lounges and have access to a garden. Tregolls Manor is located in the city of Truro in Cornwall.

People’s experience of using this service and what we found

At the previous inspection we made a recommendation as Medication Administration Records (MAR) when compared to the actual medicines in stock did not always tally. We found this remained the case. We identified further concerns in relation to medicines management. For example, administration instructions for people’s medicines were not always confirmed when they moved in to the service. MAR records did not always record the administering directions as written on the persons medicine package. This led to confusion as to the timings and dosage of when medicines were to be administered which could potentially lead to a person being over or under medicated. When people had declined their medication for a number of days this had not been followed up or reported to the doctor to be reviewed. Some medicines were administered ‘as required’. However, there was a lack of guidance in what circumstances this medicine for the individual should be offered or administered.

At the previous inspection we recommended the service ensured that when a risk had been identified for a person this was transferred to the person’s care plan. We found that risks, whilst identified had still not always been updated on their care plan.

Care plans would benefit from expansion to provide staff with more detailed information. For example, information on events likely to cause people anxiety and advice on how to provide support at these times. Care plans were reviewed but when people’s needs had changed, they were not always updated on the person’s care plan. This placed people at risk of receiving inconsistent care. Some of the terminology used in daily records would benefit from review to ensure that they were more respectful towards people.

At the last two inspections we recommended that confidential information must be stored securely. This still had not been addressed. We continued to find people’s care records were left in public areas and accessible to all who lived, worked or visited the service.

The registered manager had not notified CQC of incidents in line with the regulations. For example, they had not notified us of falls or when a person required medical attention. The provider was not open and transparent about incidents and how they would learn from them.

People using the service consistently told us they felt safe and that staff were caring and respectful. Comments included; "I am so happy here” and “Staff are lovely and kind.”

Relatives were complimentary about the quality of care that their family member received. Comments included; “Mum calls staff her friends, they make her laugh, they know what she likes, she and her room are always clean” and “We are so thankful for all that you did for not only my mother but also for [relatives names]. Everybody played their part in providing excellent professional care that made such a difference to my mother’s quality of life over the last 4 years. We owe you a huge debt of gratitude and sometimes thank you doesn’t seem to say it all but please know that it is said from the heart and we will never forget your kindness’.”

We observed many kind and caring interactions between staff and people. Staff spent time chatting with people and knew the people they supported well.

There were some staff vacancies at the time of this inspection. Regular agency staff were being used to cover these absences whilst a recruitment campaign was on going. Duty rotas confirmed that there was always a mix of permanent and agency staff on duty so that people were supported by familiar staff. Staff told us “We are busy, but some days are better than others” and “We have agency staff to help out, they know the home and people well.” People told us that staff respond in a timely manner when they called for assistance.

All necessary recruitments checks had been completed. New staff completed an induction and staff training was regularly updated.

The provider had effective safeguarding systems in place and all staff had a good understanding of what to do to help ensure people were protected from the risk of harm or abuse.

The food provided by the service was enjoyed by people.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately

Staff were motivated and fully focused on ensuring people's needs were met.

Relatives were complimentary about the service and told us that the registered manager and staff communicated well with them and knew their family member well.

People and their relatives were involved in decisions about people’s care and kept informed of any changes to the running of the service. Relatives and staff told us the registered manager and staff were approachable and listened when any concerns or ideas were raised.

Rating at last inspection and update: At the last inspection the service was rated as good (12 December 2019). We also undertook an inspection visit to look at infection control practices but did not rate the service at that time (published 29 January 2021).

Why we inspected

We undertook this focused inspection to check on specific concerns we had about the service. We received concerns in relation to staffing levels and the impact this had on the quality of care and support that was being provided. We also received some concerns about medicines and how issues were responded to by the management team. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from these concerns.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvement. Please see the safe and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Tregolls Manor on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified three breaches in relation to systems and processes, medicines and failure to notify us of incidents that occurred at the service. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an updated action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Tregolls Manor is registered to provide accommodation with personal and nursing care for up to 25 people. There were 17 predominantly older people using the service at the time of our inspection.

People’s experience of using this service and what we found

People were relaxed and comfortable with staff and interacted well with each other. Staff were caring and spent time talking with people as they moved around the service.

People told us they felt safe at the service, there was sufficient staff on duty and that they were well cared for. Comments included “It’s like a family here” and “We are very lucky”.

Concerns had been raised with us regarding infection prevention control procedures and we were assured that the provider was adhering to the national guidance. However, we identified that care and domestic staff were wearing the correct PPE at all times, but office staff and visitors were not. The manager took action immediately to ensure this was done.

The building was clean, and there were appropriate procedures to ensure any infection control risks were minimised. Cleaning and infection control procedures had been updated in line with Public Health England (PHE) Covid-19 guidance to help protect people, visitors and staff from the risk of infection.

There were sufficient staff on duty to meet people’s needs. The service used regular agency staff, to cover any shifts.

People received their medicines safely and on time. Clear procedures were in place and staff received medicines training. We found the majority of medicines tallied, however there were two occasions where medicines had been carried over from previous stock and this made the medication tally incorrect. We have made a recommendation about the management of some medicines.

Risks for people were not always identified, and staff had some guidance in place to help them support people to reduce the risk of avoidable harm. Emergency plans in how to evacuate the building were not person centred. We have made recommendations about risk management.

The service had suitable safeguarding systems in place, and staff knew how to recognise and what to do if they suspected abuse was occurring.

Staff and people told us they felt able to approach the management team with any concerns and felt they would be listened to.

Rating at last inspection

The last rating for this service was Good (published 12 December 2019).

Why we inspected

We undertook this targeted inspection to check on specific concerns we had about the service. We received concerns in relation to staffing levels and the impact this had on the quality of care and support that was being provided. We also received some concerns about medicines and how issues were responded to by the management team. The overall rating for the service has not changed following this targeted inspection and remains as good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We found no evidence during this inspection that people were at risk of harm from these concerns.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Waters Park on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Tregolls Manor provides accommodation with personal care for up to 25 people. There were 23 predominantly older people using the service at the time of our inspection.

People’s experience of using this service and what we found:

People using the service consistently told us they felt safe and that staff were caring and respectful. Comments included “Staff are excellent, loving really. Atmosphere is good”. Relatives told us “Oh, it's lovely, like a hotel really” and “I visit most days, staff are always here to talk to me about any changes”.

We observed many kind and caring interactions between staff and people. Staff spent time chatting with people as they moved around the service.

Staff were proud to work at Tregolls manor and spoke of the people they supported fondly. Comments included, “The main thing is the residents”, “I love my job, helping everyone, making a difference” and “Feel very blessed to be here, we appreciate it's a good home.” Agency staff commented, “It’s like a big family, they care about each other. Not a single member of staff who doesn’t care, it’s how a residential care home should be run.”

There were some staff vacancies at the time of this inspection. Regular agency staff were being used to cover these absences whilst a recruitment campaign was on going. Duty rotas confirmed that there was always a mix of permanent and agency staff on duty so that people were supported from familiar staff. A relative told us “We are aware of the pressure and stress on staff, but it doesn’t take away the quality of care.”

All necessary recruitments checks had been completed and people were safely supported to take their medicines as prescribed.

The provider had effective safeguarding systems in place and all staff had a good understanding of what to do to help ensure people were protected from the risk of harm or abuse. People told us they felt safe. A relative said, “We are so pleased with everything, totally confident she (person) is safe.”

Risks were identified, assessed monitored and reviewed. The risk assessment forms needed to be expanded as the guidance provided for staff on how to protect people from known risks while maintaining their independence was limited. We have made a recommendation about this in the Safe section of the report. Following the inspection, the registered manager told us they were to implement new risk assessment systems to provide more detailed guidance for staff in how to mitigate risks.

Staff had received appropriate training and support to enable them to meet people needs.

People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The food provided by the service was enjoyed by people. Comments included “We get a choice, chef comes round with the menu and you can pick what you want” and “Food is very good with plenty of choice, whatever you want, three good meals a day.”

People had access to a range of meaningful activities both in the service and in the local community that met their individual social and emotional needs.

People were involved in the development and review of their care plans. These documents provided staff with enough information to enable them to meet people’s needs.

The service was well led. Management roles were clearly defined and there were effective quality assurance processes in place. People and managers attended regular ‘Tregolls club meetings’ so that views on the running of the service could be shared. People were complimentary of the service and relatives told us, “Its top notch here”.

Audits were carried out regularly to monitor the service provided. Actions from these audits were being acted upon to further improve the service.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately.

We found people’s care documentation was not always kept in a secure manner. We have made a recommendation about this in the caring section of the report.

Rating at last inspection and update: At the last inspection the service was rated as Good (30 June 2017). At this inspection we found the rating remained as Good.

Why we inspected; This was a planned inspection based on the previous rating.

Follow up: We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This unannounced comprehensive inspection took place on 31 May 2017. The last comprehensive inspection took place on 30 June 2015 we found a breach of the legal requirements at this inspection. It was not clear from the medicine records if some people had received their prescribed medicines, the safeguarding adults policy required updating and accidents and incidents were not formally audited. Identified risks in people’s care plans did not always have guidance for staff on how to reduce such risks. Following the inspection the provider sent the Care Quality Commission an action plan outlining how they would address the identified breach. A focused inspection was carried out on 27 February 2017 to check on the action taken by the provider to address the concerns found at the previous inspection. The service had taken appropriate action to address the breach of regulations and was found to be meeting the regulations at that time.

Tregolls Manor is a care home which offers care and support for up to 25 predominantly older people. At the time of the inspection there were 20 people living at the service. Two people were staying for a short respite period. Some of these people were living with dementia.

People told us, “I am very happy here, I feel safe and cared for” and “I have no concerns at all the staff are all wonderful.”

Families told us, “It is like a five star hotel, it does not feel anything like a care home, it always smells lovely” and “They provide immense dignity for people, hiding away anything that looks clinical.”

Some people living at the service were living with dementia, had very poor sight but were able to move around independently. Toilets, bathrooms and people’s bedrooms were marked with small brass plates with words or numbers only. There was no pictorial signage throughout the service to support people who required additional prompts to recognise their surroundings. There were no supportive handrails in the corridors or gates over open stairways to support people who had been identified as being at risk from falls. Families told us they did not consider this was an issue as their relatives were able to find their way around the building without difficulty. We discussed this with the registered manager who assured us people’s individual needs would be monitored and any additional adaptations required would be discussed with the provider.

The registered manager held a record of staff training, showing when staff had attended specific training. Some staff were due updates on mandatory annual training such as fire safety, moving and handling and health and safety. These updates were scheduled to take place in the planned training programme

We reviewed the Medicine Administration Records (MAR). We found it was mostly possible to establish if people had received their medicines as prescribed. We found some gaps in these records were there was no signature against the time when a medicine was due to be given. Regular medicines audits were consistently identifying when such errors occurred and these were taken up with individual staff. This had led to a reduction in such issues.

Staff were supported by a system of induction training, supervision and appraisals. People were supported by staff who knew how to recognise abuse and how to respond to concerns. Risks in relation to people’s daily lives were assessed and planned for to minimise the risk of harm. Staff meetings were held regularly. These allowed staff to air any concerns or suggestions they had regarding the running of the service.

The service was well decorated, comfortable and clean. There was a programme of regular maintenance and re-decoration of the building. People were treated with kindness, compassion and respect.

The service had identified the minimum numbers of staff required to meet people’s needs and these were being met.

People's rights were mostly protected because staff acted in accordance with the Mental Capacity Act 2005. The registered manager was aware of the principles of the Deprivation of Liberty Safeguards and applications had been made to the local authority for authorisations of potentially restrictive care plans. However, a further application was identified at this inspection as necessary. The registered manager assured us this would be made immediately. No authorisations had been granted at the time of this inspection.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy.

Care plans were well organised and contained accurate and up to date information. Care planning was reviewed regularly and people’s changing needs recorded. Where appropriate, relatives were included in the reviews. Some people had specific healthcare needs and there was not always adequate guidance and direction for staff on how to meet those needs. However, staff knew people who lived at Tregolls Manor well and were providing appropriate care to people.

People had access to regular activities. The registered manager arranged regular visits from entertainers. These events included musicians, singers and games. The service had a vehicle that enabled several people to have regular trips out in to the local community.

The registered manager was supported by a developing team of care co-ordinators who each had responsibilities for different areas of the running of the service.

We carried out a comprehensive inspection on 30 June 2015. A breach of the legal requirements was found. This was because the arrangements in place for the assessment, monitoring and mitigation of risks were not robust. Some aspects of medicines management were not always effective and accidents and incidents which occurred at the service were not audited to help reduce the risk of re occurrence.

After the comprehensive inspection the registered provider wrote to us to say what they would do to meet the legal requirements in relation to the breach. As a result we undertook a focused inspection on the 27 February 2017 to check they had followed their plan and to confirm they now met legal requirements.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Tregolls Manor on our website at www.cqc.org.uk

Tregolls Manor is a care home for up to 25 older people, some people living at the service were living with dementia. At the time of the focussed inspection on 27 February 2017 there were 23 people living at the service.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At this focused inspection we found the registered provider had met the legal requirements of regulations. Medicines were being regularly audited and any concerns were being taken up with specific members of staff. Risks were being identified, assessed and reviewed regularly in order to take account of any changes. Accidents and incidents were being recorded appropriately and audited to help identify any patterns or trends and reduce the risk of re occurence.

People who use the service told us the staff were kind and very good. One person told us, " The care couldn't be better, food is good, I'm happy".

Another person when asked if they could do better by the manager replied, "Don't think you could, it's a dream".

People told us they had no complaints and were able to speak to the manager if they did. People were happy with the food and choices.

We found that staff received training that enabled them to meet people's needs. The home was clean, there were systems in place to minimise infection.

The provider had quality assurance systems in place that ensured people were safe and changes could be made to improve the service provided.

All the relatives that we spoke to made positive comments about the care people received.

We asked staff's views about working at Tregolls Manor. One member of staff told us, "We have enough time to give care, that's what I like about it here".

The home was furnished and decorated to a high standard although some of the paint work and decorations were beginning to be in need of refreshment. However the registered manager said the owner had a plan to decorate some of the communal areas. The bedrooms were decorated and furnished to a good standard. Health and safety standards were generally to a good standard.

When we inspected the home was clean and odour free. Staffing levels were to a good standard. There was evidence that suitable recruitment checks were completed. There were some gaps in records regarding the provision of training. Staff however were observed working professionally with the people living in the home. Quality assurance systems were satisfactory.